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Braun S, Brenneis M, Schönnagel L, Caffard T, Diaremes P. Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients. Life (Basel) 2023; 13:1341. [PMID: 37374124 DOI: 10.3390/life13061341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Lukas Schönnagel
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 10117 Berlin, Germany
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, 89075 Ulm, Germany
| | - Panagiotis Diaremes
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
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Moustafa IM, Shousha T, Arumugam A, Harrison DE. Is Thoracic Kyphosis Relevant to Pain, Autonomic Nervous System Function, Disability, and Cervical Sensorimotor Control in Patients with Chronic Nonspecific Neck Pain? J Clin Med 2023; 12:jcm12113707. [PMID: 37297903 DOI: 10.3390/jcm12113707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
There is great interest in thoracic kyphosis, as it is thought to be a contributor to neck pain, neck disability, and sensorimotor control measures; however, this has not been completely investigated in treatment or case control studies. This case control design investigated participants with non-specific chronic neck pain. Eighty participants with a defined hyper-kyphosis (>55°) were compared to eighty matched participants with normal thoracic kyphosis (<55°). Participants were matched for age and neck pain duration. Hyper-kyphosis was further categorized into two distinct types: postural kyphosis (PK) and Scheuermann's kyphosis (SK). Posture measures included formetric thoracic kyphosis and the craniovertebral angle (CVA) to assess forward head posture. Sensorimotor control was assessed by the following measures: smooth pursuit neck torsion test (SPNT), overall stability index (OSI), and left and right rotation repositioning accuracy. A measure of autonomic nervous system function included the amplitude and latency of skin sympathetic response (SSR). Differences in variable measures were examined using the Student's t-test to compare the means of continuous variables between the two groups. One-way ANOVA was used to compare mean values in the three groups: postural kyphosis, Scheuermann's kyphosis, and normal kyphosis group. Pearson correlation was used to evaluate the relationship between participant's thoracic kyphosis magnitude (in each group separately and as an entire population) and their CVA, SPNT, OSI, head repositioning accuracy, and SSR latency and amplitude. Hyper-kyphosis participants had a significantly greater neck disability index compared to the normal kyphosis group (p < 0.001) with the SK group having greatest disability (p < 0.001). Statistically significant differences between the two kyphosis groups and the normal kyphosis group for all the sensorimotor measured variables were identified with the SK group having the most decreased efficiency of the measures in the hyper-kyphosis group, including: SPNT, OSI, and left and right rotation repositioning accuracy. In addition, there was a significant difference in neurophysiological findings for SSR amplitude (entire sample of kyphosis vs. normal kyphosis, p < 0.001), but there was no significant difference for SSR latency (p = 0.07). The CVA was significantly greater in the hyper-kyphosis group (p < 0.001). The magnitude of the thoracic kyphosis correlated with worsening CVA (with the SK group having the smallest CVA; p < 0.001) and the magnitude of the decreased efficiency of the sensorimotor control measures and the amplitude and latency of the SSR. The PK group, overall, showed the greatest correlations between thoracic kyphosis and measured variables. Participants with hyper-thoracic kyphosis exhibited abnormal sensorimotor control and autonomic nervous system dysfunction compared to those with normal thoracic kyphosis.
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Affiliation(s)
- Ibrahim M Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Tamer Shousha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Sustainable Engineering Asset Management Research Group, RISE-Research Institute of Sciences and Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Deed E Harrison
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA
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Schreiber S, Whibley D, Somers EC. Schroth Physiotherapeutic Scoliosis-Specific Exercise (PSSE) Trials-Systematic Review of Methods and Recommendations for Future Research. CHILDREN (BASEL, SWITZERLAND) 2023; 10:954. [PMID: 37371186 DOI: 10.3390/children10060954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
The Schroth method is a non-operative treatment for scoliosis and kyphosis, used standalone or as an adjunct to bracing. While supporting evidence for its effectiveness is emerging, methodologic standardization and rigor are equivocal. Thus, we aimed to systematically review methods of published Schroth physiotherapeutic scoliosis-specific exercise (PSSE) trials and provide guidance for future research. We searched six databases for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSIs) investigating the effect of Schroth in children and adults with scoliosis or kyphosis. General characteristics, methodological approaches, treatment protocols, and outcomes reporting were analyzed. Risk of bias (RoB) was assessed using an adapted Cochrane RoB2 tool for RCTs and ROBINS-I for NRSI. Eligible studies (n = 7) were conducted in six countries and included patients with Scheuermann's kyphosis (n = 1) and adolescent idiopathic scoliosis (n = 6). Though all seven studies used the term Schroth to describe their interventions, the Schroth method was used in four of seven studies, of which only one used Schroth classification, three used Schroth therapists, and none prospectively registered the study protocol. Overall, methodological rigor was suboptimal, potentially invalidating evidence synthesis. Authors should follow minimum standards for reporting, including prospectively registering detailed protocols; using appropriate exercise labeling, Schroth classification and certified therapists; naming and describing exercises per classification; and providing therapy dosages, prescription methods, and adherence.
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Affiliation(s)
- Sanja Schreiber
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
- Curvy Spine-Specialized Scoliosis, Kyphosis and Other Spinal Disorders Centre, Edmonton, AB T6E 1W7, Canada
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Emily C Somers
- Departments of Internal Medicine, Environmental Health Sciences and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
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Muccio M, Atun-Einy O, Kafri M, Kaplan SL. Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article. Phys Occup Ther Pediatr 2023; 43:741-758. [PMID: 36922700 DOI: 10.1080/01942638.2023.2186198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/13/2022] [Accepted: 02/17/2023] [Indexed: 03/18/2023]
Abstract
AIM This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration. METHODS Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework. CONCLUSIONS AND IMPLICATIONS As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.
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Affiliation(s)
- Marissa Muccio
- Division of PRNY PC, Scoliosis Specialty Center, Totowa, NJ, USA
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
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Graham P. Scheuermann's Kyphosis. Orthop Nurs 2023; 42:53-55. [PMID: 36702097 DOI: 10.1097/nor.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Patrick Graham
- Patrick Graham, MSN, RN, APRN/ANP-BC, Banner University Medical Center Tuscon, Tuscon, AZ
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Dimitrijević V, Šćepanović T, Jevtić N, Rašković B, Milankov V, Milosević Z, Ninković SS, Chockalingam N, Obradović B, Drid P. Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16730. [PMID: 36554613 PMCID: PMC9779560 DOI: 10.3390/ijerph192416730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth's method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: "Schroth exercise", "idiopathic scoliosis", "Cobb angle", "angle of trunk rotation", and "quality of life". Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. (3) Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = -0.492, p ˂ 0.005); ATR (ES = -0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). (4) Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis.
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Affiliation(s)
- Vanja Dimitrijević
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Tijana Šćepanović
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | - Bojan Rašković
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Vukadin Milankov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Children and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia
| | - Zoran Milosević
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Srđan S. Ninković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Borislav Obradović
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
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Dimitrijević V, Viduka D, Šćepanović T, Maksimović N, Giustino V, Bianco A, Drid P. Effects of Schroth method and core stabilization exercises on idiopathic scoliosis: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3500-3511. [PMID: 36229615 DOI: 10.1007/s00586-022-07407-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/02/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Conservative approaches such as Schroth exercises and core stabilization exercises showed effective results in the treatment of idiopathic scoliosis. This study aimed to critically evaluate the magnitude effect of Schroth and core stabilization exercises using a systematic review and meta-analysis. METHODS This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The following three databases were searched for articles collection: Web of Science, PubMed, and Google Scholar. The key search terms were: Schroth exercise, core exercise, idiopathic scoliosis, Cobb angle, angle of trunk rotation, and quality of life. The articles included in our study was limited to original articles written only in English that met the following inclusion criteria: (1) Participants with idiopathic scoliosis; (2) Schroth exercises and core stabilization exercises used as interventions; (3) Cobb angle or angle of trunk rotation or quality of life used as outcome measures. RESULTS Thirteen studies were included. Depending on the outcome measured, the magnitude effect of Schroth and core stabilization exercises ranged from small to almost large as follows: Cobb angle (SMD = - 0.376, p ˂ 0.001); angle of trunk rotation (SMD = - 0.268, p = 0.104); quality of life (SMD = 0.774, p = 0.002). By subgroup analysis, Schroth method showed a larger effect size than core stabilization exercises. CONCLUSION The current systematic review and meta-analysis indicates that both Schroth method and core stabilization exercises have a positive effect in subjects with idiopathic scoliosis. Subgroup analysis showed that the Schroth method had a larger effect size than the core stabilization exercises.
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Affiliation(s)
- Vanja Dimitrijević
- Faculty of Sports and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Dejan Viduka
- Faculty of Applied Management, Economics and Finance in Belgrade, University of Business Academy, Novi Sad, Serbia
| | - Tijana Šćepanović
- Faculty of Sports and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Nebojša Maksimović
- Faculty of Sports and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Valerio Giustino
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli, 6, 90144, Palermo, Italy.
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Via Giovanni Pascoli, 6, 90144, Palermo, Italy
| | - Patrik Drid
- Faculty of Sports and Physical Education, University of Novi Sad, Novi Sad, Serbia
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Moustafa IM, Shousha TM, Walton LM, Raigangar V, Harrison DE. Reduction of Thoracic Hyper-Kyphosis Improves Short and Long Term Outcomes in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11206028. [PMID: 36294349 PMCID: PMC9604450 DOI: 10.3390/jcm11206028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022] Open
Abstract
This study investigates thoracic hyper kyphosis (THK) rehabilitation using the Denneroll™ thoracic traction orthosis (DTTO). Eighty participants, with chronic non-specific neck pain (CNSNP) and THK were randomly assigned to the control or intervention group (IG). Both groups received the multimodal program; IG received the DTTO. Outcomes included formetric thoracic kyphotic angle ICT—ITL, neck pain and disability (NDI), head repositioning accuracy (HRA), smooth pursuit neck torsion test (SPNT) and overall stability index (OSI). Measures were assessed at baseline, after 30 treatment sessions over the course of 10 weeks, and 1-year after cessation of treatment. After 10 weeks, the IG improved more in neck pain intensity (p < 0.0001) and NDI (p < 0.001). No differences were found for SPNT (p = 0.48) and left-sided HRA (p = 0.3). IG improved greater for OSI (p = 0.047) and right sided HRA (p = 0.02). Only the IG improved in THK (p < 0.001). At 1-year follow-up, a regression back to baseline values for the control group was found for pain and disability such that all outcomes favored improvement in the IG receiving the DTTO; all outcomes (p < 0.001). The addition of the DTTO to a multimodal program positively affected CNSNP outcomes at both the short and 1-year follow-up.
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Affiliation(s)
- Ibrahim Moustafa Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza 12511, Egypt
| | - Tamer Mohamed Shousha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Giza 12511, Egypt
| | - Lori M. Walton
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Veena Raigangar
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Deed E. Harrison
- Private Practice and CBP Non-Profit, Inc., Eagle, ID 83616, USA
- Correspondence:
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Etemadifar MR, Mahdinezhad Yazdi M. Evaluation of changes in kyphosis angle, apex and quality of life of patients with Scheuermann kyphosis using Kyphologic brace. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2022; 14:187-192. [PMID: 35891934 PMCID: PMC9301180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Kyphosis treatment aims to prevent curve progression and deformity correction. This study aimed to evaluate the long-term beneficial effects of Kyphologic brace treatments in patients with Scheuermann kyphosis. METHODS This retrospective case series study was performed on patients with Scheuermann kyphosis treated with a Kyphologic brace from 2013-2020. Demographic data, including age, gender, and duration of treatments, were extracted. Mean kyphosis angles before, one month and 1 year after treatments were collected. Patients were followed for at least 18 months after treatments. The location of kyphosis apex was also noted and classified into the following groups: upper thoracic, mid thoracic, lower thoracic, and thoracolumbar. RESULTS 48 patients with Scheuermann kyphosis enrolled in the present study. The mean age of the patients was 12.95 ± 1.4 years. The average follow-up time in this study was 23.02 ± 11.8 months. The mean kyphosis angle before treatments was 63.66 ± 9.51°, which decreased significantly after one month (to 43.33 ± 8.7°) and after 1 year (to 37.6 ± 9.4°) of treatments with Kyphologic brace compared to before treatments (P < 0.001). The most common location of kyphosis apex was in mid-thoracic with 77% frequency. CONCLUSIONS In this study, we showed that using a Kyphologic brace was associated with a significant reduction in kyphosis angle in patients. Our results emphasized the effectiveness of this brace in patients with Scheuermann kyphosis.
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Affiliation(s)
- Mohammad Reza Etemadifar
- Associate Professor of Spine Surgery, Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Masoud Mahdinezhad Yazdi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Özdemir Görgü S, Algun ZC. A randomized controlled study of the effect of functional exercises on postural kyphosis: Schroth-based three-dimensional exercises versus postural corrective exercises. Disabil Rehabil 2022:1-11. [PMID: 35694970 DOI: 10.1080/09638288.2022.2083244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the effects of postural corrective and Schroth-based three-dimensional exercises on thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), balance and quality of life (QoL) in individuals with postural kyphosis. METHODS This was a single-blind randomized controlled clinical trial with a total of 63 subjects (57 women, 6 men) with TKA of ≥40°. Subjects were separated into three groups: postural corrective exercise group (PCEG), Schroth-based three-dimensional exercise group (SBEG) and control group (CG). Participants in the exercise groups participated in the exercise program twice a week for eight weeks under the supervision of a physiotherapist: CG performed no exercise but was generally informed. The primary outcome variable was TKA. Secondary outcome variables were LLA, balance and QoL. RESULTS After the functional exercise programs, TKA (mean change for PCEG, SBEG: -9.71, -14.76, p < 0.001), static postural stability index overall (-0.22, -0.40, p < 0.05), and QoL (-0.41, -0.37, p < 0.001) significantly improved in both training groups compared with CG. The LLA (-3.95, p = 0.003) was significantly lower in the SBEG group than in CG. CONCLUSION This study demonstrated that Schroth-based three-dimensional exercises are an effective treatment for individuals with postural kyphosis and have a large effect size that improves TKA, LLA, balance and QoL. Clinical trial registration number: NCT03706495 Implications for rehabilitationEight weeks of postural corrective or Schroth-based three-dimensional functional exercise programs are effective in addressing thoracic kyphosis angle (TKA), balance, and quality of life in individuals with postural kyphosis.An eight-week Schroth-based three-dimensional exercise program was more effective than postural corrective exercises in improving TKA, lumbar lordosis angle, and balance for patients with postural kyphosis.Schroth-based three-dimensional exercise programs could promote balance and spinal health in young adults with thoracic kyphosis.
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Affiliation(s)
- Sena Özdemir Görgü
- Department of Physical Therapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol Universty, Istanbul, Turkey.,Department of Orthosis and Prosthetics, School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Zeliha C Algun
- Department of Physical Therapy and Rehabilitation, School of Health Sciences, Istanbul Medipol Universty, Istanbul, Turkey
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11
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Diaremes P, Braun S, Meurer A. [Scheuermann's disease]. DER ORTHOPADE 2022; 51:339-348. [PMID: 35290495 DOI: 10.1007/s00132-022-04239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 10/18/2022]
Abstract
Scheuermann's disease represents the second most common deformity of the growing spine after the various forms of scoliosis. In cases of early diagnosis and mild kyphotic deformity conservative treatment with a brace and physiotherapy shows very good results; however, in cases of neurologic deficits, curve progression despite conservative treatment and increasing pain symptoms with a Stagnara angle of more than 70-75°, surgical treatment is meaningful. The surgical strategy can include posterior spondylodesis with prior anterior release or posterior instrumentation with posterior column osteotomy depending on the surgeon's experience. The choice of the extent of the operation with the vertebrae to be instrumented and including the straightening method should be oriented to the avoidance of complications, such as proximal or distal junctional kyphosis.
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Affiliation(s)
- Panagiotis Diaremes
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland.
| | - Sebastian Braun
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
| | - Andrea Meurer
- Klinik für Orthopädie (Friedrichsheim), Universitätsklinikum Frankfurt, Marienburgstr. 2, 60528, Frankfurt am Main, Deutschland
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Oakley PA, Betz JW, Harrison DE, Siskin LA, Hirsh DW. Radiophobia Overreaction: College of Chiropractors of British Columbia Revoke Full X-Ray Rights Based on Flawed Study and Radiation Fear-Mongering. Dose Response 2021; 19:15593258211033142. [PMID: 34421439 PMCID: PMC8375354 DOI: 10.1177/15593258211033142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
Fears over radiation have created irrational pressures to dissuade radiography use within chiropractic. Recently, the regulatory body for chiropractors practicing in British Columbia, Canada, the College of Chiropractors of British Columbia (CCBC), contracted Pierre Côté to review the clinical use of X-rays within the chiropractic profession. A "rapid review" was performed and published quickly and included only 9 papers, the most recent dating from 2005; they concluded, "Given the inherent risks of radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine." The CCBC then launched an immediate review of the use of X-rays by chiropractors in their jurisdiction. Member and public opinion were gathered but not presented to their members. On February 4, 2021, the College announced amendments to their Professional Conduct Handbook that revoked X-ray rights for routine/repeat assessment and management of patients with spine disorders. Here, we highlight current and historical evidence that substantiates that X-rays are not a public health threat. We also point out critical and insurmountable flaws in the single paper used to support irrational and unscientific policy that discriminates against chiropractors who practice certain forms of evidence-based X-ray-guided methods.
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Affiliation(s)
| | | | | | | | | | - International Chiropractors Association Rapid Response Research Review Subcommittee
- Private Practice, Newmarket, ON, Canada
- Private Practice, Boise, ID, USA
- CBP NonProfit, Inc, Eagle, ID, USA
- Private Practice, Green Brook, NJ, USA
- Private Practice, Laurel, MD, USA
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Oakley PA, Ehsani NN, Harrison DE. Repeat Radiography in Monitoring Structural Changes in the Treatment of Spinal Disorders in Chiropractic and Manual Medicine Practice: Evidence and Safety. Dose Response 2019; 17:1559325819891043. [PMID: 31839759 PMCID: PMC6900628 DOI: 10.1177/1559325819891043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
There is substantial evidence for normal relationships between spine and postural
parameters, as measured from radiographs of standing patients. Sagittal balance,
cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, and the more
complex understanding of the interrelations between these essential components
of normal stance have evolved to where there are known, established thresholds
for normalcy. These spinal parameters are reliably measured from X-ray images
and serve as goals of care in the treatment of spine and postural disorders.
Initial and follow-up spinal imaging by X-ray is thus crucial for the practice
of contemporary and evidence-based structural rehabilitation. Recent studies
have demonstrated that improvement in the spine and posture by nonsurgical
methods offers superior long-term patient outcomes versus conventional methods
that only temporarily treat pain/dysfunction. Low-dose radiation from repeated
X-ray imaging in treating subluxated patients is substantially below the known
threshold for harm and is within background radiation exposures. Since
alternative imaging methods are not clinically practical at this time, plain
radiography remains the standard for spinal imaging. It is safe when used in a
repeated fashion for quantifying pre–post spine and postural subluxation and
deformity patterns in the practice of structural correction methods by
chiropractic and other manual medicine practices.
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Ehsani NN, Oakley PA, Harrison DE. Scheuermann’s disease: non-surgical improvement in whole spine sagittal alignment in the treatment of a symptomatic patient using Chiropractic BioPhysics<sup>®</sup> technique. J Phys Ther Sci 2019; 31:965-970. [PMID: 31871386 PMCID: PMC6879408 DOI: 10.1589/jpts.31.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To present the dramatic improvement of sagittal posture in a young male with
Scheuermann’s disease suffering from pain ailments as treated by Chiropractic
BioPhysics® technique. [Participant and Methods] An 18 year old reported low
back pain and headaches for several years. Full spine radiographic assessment revealed
pronounced thoracic hyperkyphosis, anterior head translation, posterior thoracolumbar
sagittal balance, and a reduced sacral base orientation. The patient was treated by
Chiropractic BioPhysics methods incorporating mirror image® exercises,
traction, as well as spinal manipulation. [Results] Assessment after 35 treatment sessions
over 14-weeks revealed a dramatic improvement in postural parameters. The thoracic
kyphosis reduced by 13°, and was accompanied by a reduction in forward head posture,
reduction in posterior sagittal balance, and an increase in sacral base angle to normal.
The low back pain and headaches were alleviated. [Conclusion] This case adds to the
accumulating evidence demonstrating CBP methods offers an effective approach to reduce the
burden of postural disorders including those with Scheuermann’s disease. Since thoracic
hyperkyphosis is a serious disorder, the routine comprehensive assessment via full-spine
radiography is essential for the quantification of relevant postural parameters.
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